UL Hospitals Group began live-streaming robotic surgical procedures from the operating room in University Hospital Limerick (UHL) to the new Clinical Education and Research Centre (CERC) at the weekend, as part of the educational component of the Group’s robotic surgical programme. The next step is to live-stream to lecture theatres in University of Limreick's Graduate Entry Medical School (GEMS).

Three-hundred-and-sixty degree live streaming will now form part of surgical training and medical education for GEMS students and students across all healthcare and medical disciplines from University of Limerick (UL). It will also form a strong educational component for non-consultant hospital doctors/registrars, nursing staff and allied health professionals working in the UL Hospitals Group.

On Saturday, November 25, more than 100 consultant urologists, colorectal surgeons, senior registrars, gynaecologists and health professionals from around the country watched the inaugural live-stream of a robotic surgical procedure at the annual South West Urological Meeting held in the state-of-the-art CERC building which was jointly funded by the Health Service Executive and University of Limerick

The surgery was carried out by renowned consultant urological surgeon and honorary senior lecturer, Guy's Hospital and King's College London, Mr Ben Challacombe, who was invited by the UHL robotic team to perform this surgery with them.

"It is a great honour to come to UHL and to demonstrate complex robotic kidney surgery using the new live streaming technology, I would like to thank the team at UHL for inviting me, the teamwork and professionalism of the whole surgical team here in Limerick is second to none," Mr Challacombe said.

In November last year, UHL became the first public hospital in Ireland to perform colorectal, kidney and adrenal surgical procedures using the Da Vinci Xi Dual Console Robot. One year on, over 110 colorectal, adrenal, kidney and other urological cases have been performed.

The Da Vinci Xi technology has particular advancements not available with standard keyhole surgery. 3D-HD visualisation provides surgeons with a highly magnified view, virtually extending their eyes and hands into the patient, almost as if the surgeon were ‘standing inside the abdomen and reaching out to the organs’. The robot is secured or ‘docked’ to the patient and has four working arms (each requiring only an 8mm skin incision) to which operating instruments are attached. Once docked, the robotic arms and instruments are controlled by the surgeon, or surgeons, who are seated at the consoles nearby. The instruments are extremely precise, with no tremor, and they can in fact achieve activities not possible with the human hand, though they would never replace the human hand, they are completely controlled by the surgeon.

Professor J. Calvin Coffey, Foundation Chair of Surgery GEMS, UL and general and colorectal surgeon, UHL, explained the enormous benefits of the live-streaming technology for students: “To date, surgical lectures at GEMS have taken place using video or powerpoint presentations; students do not have access to cadavers. Now, with our new live-streaming technology, students can observe complex operations live and interact from the classroom with the surgeons in the theatre. They can view the anatomy of the patient close up and observe the robotic arms and instruments, providing an unrivalled educational opportunity.”

“The robotic programme at UL Hospitals has been developed to bring the highest international quality standard of robotic surgery to the Midwest Region providing equity of access to all patients. Up to now, robotic surgery has been embedded in the private sector, apart from gynaecologic surgery. For the past year, it has been available to public and private patients alike with over 110 cases performed across colorectal, adrenal, kidney and gynaecological disciplines,” said Professor Coffey.

Speaking about the benefits to surgeons (trainee and trainers), consultant urologist, robotic surgeon at UHL and Chair of the South West Urological Meeting Mr Subhasis Giri added, "The Da Vinci dual console allows two surgeons to operate in synergy with pooling of expertise and maximising patient benefit in complex cases in a multidisciplinary setting. This also greatly facilitates dedicated robotic training for the surgeons of tomorrow, which to date is not available anywhere else in Ireland. Now, with 360 degree live-streaming from the operating room (OR), all of our residents can not only observe this surgery and 360 degree perspective of the operating theatre, but can also see a ‘robots-eye-view’ of the inside of the patient and ask practical questions to the surgeon or any member of the theatre team in real time. While technical skills are important, young surgeons also need to learn how to manage the stresses of the actual OR , it’s difficult to learn this from a simulated environment".

The next step is to live-stream to lecture theatres in UL, the other hospitals within UL Hospitals Group and then globally using the new technology, where students, doctors and medical professionals will be able to log onto the web based live-stream system using a password. Whilst the current live-streaming technology is in 2D, it is envisaged that this will soon be available in 3D.

UL, academic partner to UL Hospitals Group, donated €135,000 to the project for Audio Visual and training equipment and a further €22,000 was donated from the UL MELG (Medical Education Liaison Group) Fund for Live Streaming equipment this year.

Des Leddin, Head of the Graduate Entry Medical School (GEMS) at University of Limerick commented: "At UL, we are delighted to have access to this marvellous teaching tool for our students, allowing them to observe complex operations 'live' alongside our top surgeons. Not only will this experience be educationally enriching but I believe that it will also inspire the next generation of high-tech surgeons”.

Colette Cowan, CEO of UL Hospitals Group commented, “Since the robotic programme ommenced last year, we have begun to substitute keyhole surgery with robotic surgery where it’s possible at UHL and the benefits to our patients are enormous. Today, we have seen the huge educational benefits of the robotic programme for our young surgeons and for medical students alike, which is enhanced with the new live streaming technology. I know that I am immensely proud to see this come to fruition and I hope that it will serve them well in their careers into the future".

Robotic surgery represents the highest international standard of surgery worldwide and is the most advanced form of key hole surgery available to patients. Data from UL Hospitals Group demonstrates that post-operative recovery is twice as fast with robotic surgery than with standard keyhole surgery, with an average postoperative hospital stay of approximately four days. There is also minimal blood loss and a reduction in post-operative pain with robotic surgery.

The Da Vinci Xi program continues to develop under the guidance of Ms Suzanne Dunne, head of strategy UL Hospitals Group and Project Manager for the Robotic Surgery Program. According to Suzanne, “Three components have been fundamental in the program’s success to date; team collaboration and engagement, the multidisciplinary Robotic Assisted Surgery (RAS) forum and the significant data analysis which is collated weekly. The data is crucial in term of patient outcomes, quality improvement, performance and financial monitoring”.

The robotic program was recently further strengthened by Mr Colin Peirce who has developed the robotic assisted program for colorectal surgery. Mr Peirce has also coordinated educational courses, published in Techniques of Coloproctology on the usage of the Dual Console, and delivered international lectures on the topic.

The Da Vinci Xi robotic programme at UL Hospitals Group cost €2.8 million in total and was supported by the Midwestern Hospitals Development Trust, the JP McManus Benevolent Fund, University of Limerick and UL Graduate Entry Medical School. Valued at approximately €2.6m, the Da Vinci Xi robot and equipment was donated by the Midwestern Hospitals Development Trust and funded with the generous support of the JP McManus Benevolent Fund. The CERC development is a partnership project between UL Hospitals and the University of Limerick (UL) and is co-funded by both the HSE and UL with an overall project cost of circa €12.75m. The CERC accommodates and supports the comprehensive educational, training and research needs of both the UL Graduate Entry Medical School and the UL Hospitals medical community across all disciplines.